How CaroMont will deal with the Affordable Care Act

In this Gazette file photo, professionals in the health care industry meet to discuss the Affordable Care Act.

By Michael Barrett

Published: Monday, September 30, 2013 at 05:46 PM.

How many more people will have to be insured in
Gaston
County
?
U.S.
census data indicates that almost 14,000
Gaston
County
residents could potentially enroll in the online health insurance marketplace as a result of the Affordable Care Act.

How might the doctor-patient ratio at CaroMont Regional Medical Center be affected by the changes? How is the hospital preparing for a potential influx of new patients? Officials at CaroMont Health say they don’t foresee patient volume within their system will change significantly. More people whose only option used to be the emergency department will soon have better health care options, they say.

“Parameters of the Affordable Care Act will transition more individuals to an insured status and not necessarily create an influx of new patients,” said CaroMont Health spokeswoman Dallas Paddon. “When covered by insurance options offered through the marketplace, these individuals will be able to visit a primary care provider for preventive health needs, rather than seeking care in the emergency setting.”

Critics of the Affordable Care Act predict a nationwide shortage of primary-care doctors — especially in poor and rural areas — will make it difficult for many of the newly insured to find a personal physician. Theoretically, that could steer even more people to the emergency department. Emergency departments are also declining in number. A report by the American Hospital Association notes that years of hospital closures have left the nation with 650 fewer emergency rooms than 20 years ago.

Paddon emphasized CaroMont has more than 20 primary care practices to provide that type of care, limiting the burden on local emergency departments.

Why does it matter to already insured patients that more people are covered through the Affordable Care Act? Universal health care coverage can’t sustain itself unless healthy people buy in along with those who are sick, or at risk of becoming so. It’s really just the basic philosophy of insurance, said Robert Spencer, executive director of Gaston Family Health Services. His organization is helping to disseminate information about the health care changes, particularly to those who will qualify for a subsidy to help buy coverage.

“You’re spreading your risk over a pool,” he said. “Many of the users will not use the system heavily, and that in turn will fund the system for the people who do use it more.” Healthy people may be more tempted to opt out of the insurance program and simply pay the penalty for not participating.

How many more people will have to be insured in GastonCounty? U.S. census data indicates that almost 14,000 GastonCounty residents could potentially enroll in the online health insurance marketplace as a result of the Affordable Care Act.

How might the doctor-patient ratio at CaroMont Regional Medical Center be affected by the changes? How is the hospital preparing for a potential influx of new patients? Officials at CaroMont Health say they don’t foresee patient volume within their system will change significantly. More people whose only option used to be the emergency department will soon have better health care options, they say.

“Parameters of the Affordable Care Act will transition more individuals to an insured status and not necessarily create an influx of new patients,” said CaroMont Health spokeswoman Dallas Paddon. “When covered by insurance options offered through the marketplace, these individuals will be able to visit a primary care provider for preventive health needs, rather than seeking care in the emergency setting.”

Critics of the Affordable Care Act predict a nationwide shortage of primary-care doctors — especially in poor and rural areas — will make it difficult for many of the newly insured to find a personal physician. Theoretically, that could steer even more people to the emergency department. Emergency departments are also declining in number. A report by the American Hospital Association notes that years of hospital closures have left the nation with 650 fewer emergency rooms than 20 years ago.

Paddon emphasized CaroMont has more than 20 primary care practices to provide that type of care, limiting the burden on local emergency departments.

Why does it matter to already insured patients that more people are covered through the Affordable Care Act? Universal health care coverage can’t sustain itself unless healthy people buy in along with those who are sick, or at risk of becoming so. It’s really just the basic philosophy of insurance, said Robert Spencer, executive director of Gaston Family Health Services. His organization is helping to disseminate information about the health care changes, particularly to those who will qualify for a subsidy to help buy coverage.

“You’re spreading your risk over a pool,” he said. “Many of the users will not use the system heavily, and that in turn will fund the system for the people who do use it more.” Healthy people may be more tempted to opt out of the insurance program and simply pay the penalty for not participating.

“The big question is what do we do to motivate the healthy, young population to participate, in order to make sure that pool remains viable?” said Spencer. “That’s what we’re being asked to do through some of our efforts.” Increasing penalties for not having health insurance will make that tougher to justify. By 2016, the annual penalty will climb as high as $2,500.

Is there any chance doctor’s offices will soon get more crowded? Will it be harder to get appointments or have non-emergency procedures and surgeries scheduled? That’s a concern across the country, said Donna Grissom, executive director of HealthNet Gaston. “But I think the health-care community will adjust to meet the capacity,” she said.

Part of the Affordable Care Act provided money to help increase the number of mid-level providers, such as physician assistants, to address the increased need, Grissom said. “There may be some issues, but I feel like the community will adapt to it,” she said. North Carolina’s decision to not expand its Medicaid program should mean less pressure on the system because it will mean fewer people with health-care coverage.

“The answer to the question I think is there will certainly be an increase in demand,” he said. “I’d say it will be substantively smaller in North Carolina without the Medicaid expansion.”

How might hospitals be required to focus on wellness? Will their reimbursements be smaller for recurring conditions? Paddon said CaroMont Health has been promoting wellness for some time now. “For a number of years, CaroMont Health has proactively planned and implemented programs and services that support the patient-centered care model, which focuses on overall wellness and effective management of chronic disease,” she said. Entities such as CaroMont Health will have an increasing incentive to emphasize wellness, Paddon said. “The health care industry is shifting to a preventive care model, placing more accountability on health care providers to help keep patients well,” she said. “In some cases, that is tied directly to reimbursement.”

You can reach Michael Barrett at 704-869-1826 or twitter.com/GazetteMike.